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- Short and Long-Term Benefits of Exercise Routines
- Compulsive Behaviors in Parkinson's Disease: Who's At Risk
For people with Parkinson’s disease (PD), different exercise routines provide different short- and long-term benefits, according to a study in the November 2012 issue of Physical Therapy. A group of researchers led by Margaret Schenkman, P.T., Ph.D., at the Anschutz Medical Campus of the University of Colorado worked with 121 people with early- or mid-stage PD. They compared three exercise routines: 1) flexibility program designed for people with PD, 2) a standard aerobic program, and 3) a control, a program of exercises from the National Parkinson Foundation.
Doctors tested participants' physical abilities, balance and walking economy both before they began exercising and after four, 10 and 16 months. The doctors did not know which people were in which group.
- In four months, participants in the flexibility group improved more than those in the other groups on a test of general fitness (tasks like making a bed and unloading groceries). There were no differences in this test between the groups at 10 and 16 months.
- As to balance, there were no differences between the groups at four, 10 or 16 months.
- In the test of walking economy (how much oxygen the participants consumed at different speeds) the aerobic group improved more than the flexibility group at four, 10 and 16 months and more than the control group at four and 16 months.
What Does it Mean?
This study is unique becasue it compared different types of exercise for a relatively long period of time. All types appear beneficial for people with PD. Specifically, the study demonstrates short-term benefits of a flexibility routine for people with PD, but also shows that the benefits may not last. Only aerobic exercise demonstrated long-term benefits. The economy of walking experienced by this group could lead to better endurance, less fatigue and fewer falls.
Based upon these results, people living with Parkinson’s could use the flexibility program to improve overall physical abilities and an aerobic program to improve long-term endurance. Most participants completed the study, suggesting that these exercises are practical, but most also reported the need for support to maintain exercise over the long term.
Scientists funded in part by the Parkinson’s Disease Foundation have identified risk factors for impulse control disorders (ICDs) — a group of side effects that are associated with medications used to treat the motor symptoms of Parkinson’s disease (PD). Their research, published in the January 2, 2013 issue of Movement Disorders, may help doctors recognize or prevent ICDs in people living with PD. Dopamine agonists play an important role in the treatment of people with PD. (This class of drugs includes bromocriptine (Parlodel®); pramipexole Mirapex®); ropinirole (Requip®); and rotigotine transdermal system (Neupro®). But the risk for ICDs — such as compulsive eating, gambling, shopping or sexual activity — remains a major concern.
Researchers led by Melissa Nirenberg, M.D., Ph.D., at Weill Cornell Medical College investigated why some people develop ICDs, while others do not. For four years, they studied 46 people with PD who were taking dopamine agonists and had no prior history of ICDs.
- Over ten years, 18 of 46 volunteers newly developed one or more ICDs.
- 12 of the 18 people who developed ICDs also experienced punding behaviors — that is, repetitive tasks such as sorting, organizing or using the Internet.
- People who developed an ICD were more likely at the start of the study to have experienced motor complications than those who did not develop an ICD.
- People who had used caffeine, smoked cigarettes during their lives, and had higher maximum doses of dopamine agonists, were more likely to develop an ICD.
- 13 of the 18 people who developed ICDs overcame them by stopping or reducing dopamine agonists.
What Does it Mean?
This study, the first to follow dopamine agonist usage over time, provides further evidence that ICDs are a relatively common side effect. It finds several possible risk factors, which may one day help doctors to identify who is at risk and prevent ICDs. The study showed that stopping dopamine agonist therapy — slowly, under the care of a doctor — was able to ease and stop ICDs. However, a some people are unable to do this because their motor symptoms worsen, or they develop a withdrawal syndrome. This study reinforces that people may not develop ICDs until years after beginning dopamine agonist therapy. It’s important for loved ones to monitor these behaviors and bring them to the attention of doctors.